- March 24, 2025
- Posted by: Josh Knoll
- Category: Medical Billing Company
For most healthcare providers medical billing is the worst nightmare. Owing to increasing rates in claim denials due to billing errors, medical facilities are facing significant revenue loss. Consequently, many hospitals are facing closures due to poor financial health. According to a recent report by ‘Baker’s Hospital Review’ 10 hospitals have closed within the first three months of 2025. Becker’s reported 14 hospital closures in 2023 and 25 in 2024. This significant number of closures is becoming a rising concern for healthcare providers.
Moreover, the Medical Billing Outsourcing Global Market Report shows that due to poor billing practices, healthcare providers lose around $125 billion each year. In-house billers face significant challenges in streamlining all administrative processes. Here, outsourced medical billing services come to the rescue. They ensure 100% billing and coding accuracy. With their assistance, healthcare providers can keep their revenue cycle short with minimized accounts receivables.
Accordingly, the medical billing outsourcing market has experienced significant growth in recent years. In 2024, it was valued at $17.02 billion. Since then, it is expanding at a CAGR of 11.5%. An increasing number of healthcare providers are choosing an outsourced medical billing company. However, choosing an efficient third-party billing specialist is not a simple task. You should check these following features while selecting a service provider.
Essential Factors to Consider When Choosing a Medical Billing Company
Experience and Expertise
Medical billing specialists need to take care of complex healthcare regulations, payer policies, medical coding, and documentation. Experienced outsourced billing specialists have an in-depth understanding of all these billing intricacies. As a result, they can efficiently eradicate billing errors that lead to claim denials. However, you must check to see if your prospective billing specialists have adequate experience. Reviews and remarks from previous customers will give a clear idea regarding their experience and expertise.
Coding Proficiency
The majority of medical claims are denied by payers for coding mistakes. Industry statistics indicate that 10-15% of denied claims are coding denials. In order to eliminate coding denials you need to hire certified professional coders. You should verify if the third-party medical coders are certified by the American Academy of Professional Coders (AAPC). Moreover, you can hire Certified Coding Specialists (CCS) from the American Health Information Management Association (AHIMA).
Compliance with Healthcare Regulations
Medical billers need to follow extensive healthcare rules such as the HIPAA Act of 1996. Nevertheless, the authorities revise their laws and regulations periodically. It is fairly difficult for in-house billing personnel to stay updated along with overseeing administrative duties. In addition, HIPAA compliance will guarantee the outsourcing firm will handle your protected health information (PHI) securely.
Efficiency in Denial Management
Appealing denied claims takes the most time and effort of in-house medical billers. Moreover, due to a lack of proper knowledge, they often fail to get denied claims approved. Therefore, healthcare providers face significant financial loss. When choosing an outsourced billing solution, you must ensure they have a good track record in denial management. Reports show that more than 50% of denied claims can be reimbursed by proper and timely appeals.
Success in Prior Authorization
About 12% of medical bills face prior authorization denials. In-house billing staff often commits documentation or coding errors that lead to pre-authorization denials. Thus, while selecting an outsourced medical billing company check their previous success rate in prior authorization. Securing prior authorization will ensure the healthcare provider will get reimbursement on time. It will keep their accounts receivables lowest all the time.
Knowledge of Payer Policies
Insurance payers like Medicare, Medicaid, and other commercial companies have separate reimbursement policies. Billing specialists must follow all their guidelines while submitting claims. Eventually, it becomes an added headache for in-house administrative staff. Moreover, on many occasions, they fail to follow updated payer policies. Outsourced billing specialists have dedicated workers who thoroughly follow updates from different payers. So, they can ensure flawless billing practices.
Finally, End-to-End RCM Solution
RCM (Revenue Cycle Management) presents a significant challenge to in-house billing staff. Hence, you must choose a billing company that offers end-to-end RCM solutions. You must ensure that they offer all the following services –
- Patient registration
- Insurance eligibility verification
- Medical coding
- Charge entry
- Cash posting and reconciliation
- Claim generation and submission
- Accounts receivable and denial management
How Sunknowledge Makes a Difference
Sunknowledge is an end-to-end medical billing company with nearly two decades of experience. We have experienced teams to streamline your billing process. With our assistance, your healthcare facility will experience the following benefits –
- We will ensure 99.9% billing accuracy that will eradicate claim denials and delayed reimbursements.
- We will submit prior authorization requests on the same day for fast approval.
- Our assistance will reduce approximately 80% of the operational costs of healthcare providers.
- With our support, healthcare providers will receive maximum reimbursements timely.
- While we attend to the administrative challenges, healthcare practitioners will be free to enhance their productivity.
Our affordable services will increase the earnings of healthcare providers. When they can streamline their administrative workload they can focus on delivering better medical services. It will create a win-win situation for both parties. Hence, why wait any longer? Get in touch with us and let us implement healthy billing practices in your organization.